Presumptive Eligibility- HIP Sample Clauses

Presumptive Eligibility- HIP. Individuals determined presumptively eligible for HIP before 1/1/2019 in accordance with 42 CFR §435.1110 will be enrolled with an MCE for a presumptively eligible period, which begins on the day a qualified hospital, qualified provider or other authorized entity makes a determination that the individual is presumptively eligible. Individuals determined EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK presumptively eligible on 1/1/2019 and after, will be in the Fee for Service program During the member’s presumptively eligible period, the Contractor shall provide health benefits equivalent to the HIP Basic plan benefits, as described in Exhibit 6 of this Contract. The member will not be provided a POWER Account during the presumptively eligible period; however, the member will be subject to copayments for services as set forth in Section 4.1.2. The Contractor shall reduce reimbursement to providers for services rendered to a presumptively eligible member by the amount of the individual’s required copayment. The presumptive eligibility period will continue in accordance with the requirements in the HIP MCE Policies and Procedures Manual but should not be longer than (1) the last day of the month following the start of the presumptive eligibility period for individuals who do not file an application; (2) the day of the IHCP application denial for individuals that file an application but are not found eligible for coverage; or (3) for individuals that file an IHCP application and are found eligible for HIP the first day of the month following the determination of eligibility. Individuals determined presumptively eligible for HIP (Adult PE) will not have a break in coverage if they are found eligible for Medicaid through the IHCP application process. Once found eligible, presumptively eligible members will be enrolled in the applicable HIP Plan. This enrollment will coincide with the end of the presumptive eligibility period and begin the 1st day of the month following the end of the presumptive eligibility period. Presumptively eligible members who made a fast track payment during the standard fast track process will be enrolled in HIP Plus. Presumptively eligible members who have not made a fast track payment will be enrolled in HIP Basic and will have the opportunity to pay to move to HIP Plus as detailed below. Members who are determined eligible under the Adult PE eligibility category during their presumptively eligible period are moved to the HIP Basic cat...
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Presumptive Eligibility- HIP. Individuals determined presumptively eligible for HIP before 1/1/2019 in accordance with 42 CFR §435.1110 will be enrolled with an MCE for a presumptively eligible period, which begins on the day a qualified hospital, qualified provider or other authorized entity makes a determination that the individual is presumptively eligible. Individuals determined presumptively eligible on 1/1/2019 and after, will be in the Fee for Service program During the member’s presumptively eligible period, the Contractor shall provide health benefits equivalent to the HIP Basic plan benefits, as described in Exhibit 6 of this Contract. The member will not be provided a POWER Account during the presumptively eligible period; however, the member will be subject to copayments for services as set forth in Section 4.1.2. The Contractor shall reduce reimbursement to providers for services rendered to a presumptively eligible member by the amount of the individual’s required copayment. The presumptive eligibility period will continue in accordance with the requirements in the HIP MCE Policies and Procedures Manual but should not be longer than (1) the last day of the month following the start of the presumptive eligibility period for individuals who do not file an application;
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Related to Presumptive Eligibility- HIP

  • Determination of Eligibility The Plan Administrator shall determine the eligibility of each Employee for participation in the Plan based upon information provided by the Employer. Such determination shall be conclusive and binding on all individuals except as otherwise provided herein or by operation of law.

  • Spousal Eligibility a. For employees hired on or after August 1, 2003: If the spouse of an employee is covered by any PEBTF health care plan, and he/she is eligible for coverage under another employer’s plan(s), the spouse shall be required to enroll in each such plan, which shall be the spouse’s primary coverage, as a condition of the spouse’s eligibility for coverage by the PEBTF plan(s), without regard to whether the spouse’s plan requires cost sharing or to whether the spouse’s employer offers an incentive to the spouse not to enroll.

  • Benefits Eligibility The City offers healthcare benefits to regularly appointed full-time and part-time employees and their qualified dependents. The plan is administered in compliance with all applicable federal, state, local laws, statutes and rules.

  • Employee Eligibility For purposes of this section, “eligible employee” shall be defined by the Public Employees’ Medical and Hospital Care Act.

  • Benefit Eligibility For purposes of the Benefit Plan entitlement, common-law and same sex relationships will apply as defined.

  • Service Eligibility A bonus authorized by subsection (a) may be paid to a person or offi- cer only if the person or officer agrees under subsection (d)—

  • Continuing Eligibility To continue health benefits, a permanent intermittent employee must be credited with a minimum of 480 paid hours in a control period or 960 paid hours in two consecutive control periods.

  • Overtime Eligibility An Employee must work at least fifteen (15) minutes beyond her normal shift before being eligible for overtime compensation.

  • Funding Eligibility Contractor understands, acknowledges, and agrees that, pursuant to Chapter 2272 (eff. Sept. 1, 2021, Ch. 2273) of the Texas Government Code, except as exempted under that Chapter, HHSC cannot contract with an abortion provider or an affiliate of an abortion provider. Contractor certifies that it is not ineligible to contract with HHSC under the terms of Chapter 2272 (eff. Sept. 1, 2021, Ch. 2273) of the Texas Government Code.

  • Member Eligibility Verify Member eligibility contemporaneous with the rendering of services. BCBS will provide systems and/or methods for verification of eligibility and benefit coverage for Members. This is furnished as a service and not as a guarantee of payment;

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